Non-Pharmacologic Managements of Rheumatic Illnesses - Enhancing Self Efficacy
Susan J. Bartlett, Ph.D.
Self-Efficacy Enhancement: Strategies for the Practitioner and Researcher (ARHP)
Basia Belza, University of Washington; Kate Lorig, Stanford University
The construct of self-efficacy received a great deal of attention at the ACR meeting this year. Simply stated, self-efficacy is the belief in one's ability to perform a specified task in the future. Why is self-efficacy of such interest to rheumatologist and other health care providers? First, it consistently has been shown to be one of the best predictors of behavior and, in turn, adaptation to illness. Second, high self-efficacy is associated with greater confidence in one's ability to cope and earlier initiation of adaptive coping strategies. Third, self-efficacy has been related to improvements in long-term outcomes such as quality of life, health status and functional level. In essence, self-efficacy is an inner resource that can be nourished and cultivated to improve the life of anyone living with a rheumatic illness. Self-efficacy enhancement is not merely providing a "pep talk"; instead, it reflects a style of interacting with patients. Best of all, you can easily incorporate self-efficacy enhancement strategies into clinical encounters with most patients without lengthening the visit.
Dr. Kate Lorig, co-author of The Arthritis Helpbook, is one of the foremost experts in the role of self-efficacy in rheumatic diseases. In this session, she and Dr. Belza reviewed the basic strategies for building self-efficacy in patients with arthritis. Below are some examples of self-efficacy enhancement strategies provided in the session.
Strategy #1: Performance Mastery.
Performance mastery means helping patients to learn necessary skills (e.g., ask for help, increase social interactions) and create opportunities for practice over time until the skills are mastered. Help patients to identify skills deficits and offer realistic feedback on how to proceed in small steps.
Strategy #2: Modeling.
Role modeling helps people learn how to cope and what to expect through the experience of others. You can enhance learning through modeling by helping patients to connect with others with arthritis. Optimal role models are those who are good self-managers and coping effectively with their disease. While face-to-face meetings (e.g., support groups) are optimal, role modeling can occur through other avenues as well (e.g., reading literature).
Strategy #3: Reinterpretation of Physical Symptoms.
Many people with arthritis feel fatigued. While the disease may, in part, result in fatigue, other factors such as emotions (e.g., anger, fear, frustration or uncertainly), lack of physical activity and even arthritis medications themselves may play important roles. If patients believe their fatigue is caused by their arthritis, then the appropriate way to manage it is to rest. However, if the fatigue results from other common causes such as unexpressed emotions or a sedentary lifestyle, then rest may not be the best management strategy. Help patients to verbalize their interpretation of symptoms and offer alternative management strategies.
Strategy #4: Social Persuasion.
Social persuasion relies on using subtle (and sometimes not so subtle) behavioral methods to reinforce desired behaviors. Dr. Lorig recommends that health care providers use positive reinforcement to "reward" patients who are working to establish positive habits. (Positive reinforcement increases the likelihood that the behavior will be repeated.) Rewarding a patient who is thinking about joining a water aerobics class is as simple as praising their intentions ("I'm so pleased to hear you are thinking about this. Physical activity IS important and will help both you and your arthritis.") Another method is to provide a little extra attention to positive behaviors ("Tell me what you know about the program. I'll also be very interested to hear about your experiences with the program.") Quickly patients will discern that you are very interested in hearing what they will try to do and have little time for hearing only about symptoms and limitations.